Significant Cerumen

Significant Cerumen

A 30-month-old female presented to her pediatrician with concern for fever. The mother reports several days of cold-like symptoms including cough and congestion. Earlier in the day, the child developed a temperature of 102.2 F. She is fussy but continues to eat and drink. The mother has been treating the symptoms with over-the-counter antipyretics. On exam, the child looks ill without being toxic. She is well-hydrated, alert, and easily comforted in her mother’s arms. The child had a significant amount of ear wax. The following image was obtained with the Wispr digital otoscope without having to remove any of the wax.

The child’s ear is normal.

This case demonstrates the power of the Wispr digital otoscope. Even the youngest patients can have a significant amount of cerumen (ear wax). This often causes almost complete obstruction of the ear canal and blocks visualization of the tympanic membrane (TM). To properly diagnose ear pathology, a full view of the TM must be obtained. Because of the unique geometry of the Wispr Speculum, it is often possible to navigate through a “window” in the ear wax to obtain a view of the TM. That was the situation in this interesting case. Although the image is slightly blurry, it is still easy to determine that this is a normal ear. The malleus is clearly visible and there is no erythema or bulging that would be associated with acute otitis media (AOM).

The complete video shows the pediatrician carefully advancing the Wispr otoscope through a small window in the cerumen and obtaining a diagnostic view of the TM. In this case, the TM is normal, and no treatment is required. It is likely the child has a benign viral infection and can be sent home with careful return instructions.

Complete exam video